Wisdom tooth removal may lead to opiod abuse

Getting your wisdom teeth pulled is bad enough but now researchers at the University of Michigan say the experience set you up for long-term opioid use.

The Michigan scientists found that young people ages 13 to 30 who filled an opioid prescription immediately before or after they had their wisdom teeth out were nearly 2.7 times as likely as their peers to still be filling opioid prescriptions weeks or months later.

“Wisdom tooth extraction is performed 3.5 million times a year in the United States, and many dentists routinely prescribe opioids in case patients need it for post-procedure pain,” said Calista Harbaugh, M.D. “Until now, we haven’t had data on the long-term risks of opioid use after wisdom tooth extraction. We now see that a sizable number go on to fill opioid prescriptions long after we would expect they would need for recovery, and the main predictor of persistent use is whether or not they fill that initial prescription.”

Those in their late teens and twenties had the highest odds of persistent opioid use, compared with those of middle school and high school age, the researchers report in a research letter in the new issue of JAMA.

The researchers used insurance data to focus on young people who were “opioid naïve” — who hadn’t had an opioid prescription in the six months before their wisdom teeth came out, and who didn’t have any other procedures requiring anesthesia in the following year.

Other factors also predicted risk of long-term opioid use. Teens and young adults who had a history of mental health issues such as depression and anxiety, or chronic pain conditions, were more than others to go on to persistent use after filling their initial wisdom tooth-related prescription.

The authors suggest that dentists and oral surgeons should consider prescribing non-opioid painkillers before opioids to their wisdom tooth patients. If pain is acute, they should prescribe less than the seven-day opioid supply recently recommended by the American Dental Association for any acute dental pain.

“There are no prescribing recommendations specifically for wisdom tooth extraction,” says Harbaugh. “With evidence that nonsteroidal anti-inflammatories may just as, if not more, effective, a seven-day opioid recommendation may still be too much.”

About the study

In all, 1.3 percent of 56,686 wisdom tooth patients who filled their opioid prescription between 2009 and 2015 went on to persistent opioid use, defined as two or more prescriptions filled in the next year written by any provider for any reason. That’s compared with 0.5 percent of the 14,256 wisdom tooth patients who didn’t fill a prescription.

Though those numbers may seem small, the high number of wisdom teeth procedures every year mean a large number of young people are at risk, notes Harbaugh, a research fellow with the Michigan Opioid Prescribing and Engagement Network, or Michigan OPEN.

The team used data from employer-based insurance plans, available through the Truven MarketScan database purchased for researchers’ use by IHPI. Chad Brummett, M.D., co-director of Michigan OPEN, is senior author of the new research, and the team includes U-M School of Dentistry professor Romesh Nalliah, D.D.S., MHCM.

The data show opioid prescriptions filled, but not actual use of opioid pills by patients. Leftover opioids pose a risk of their own, because they can be misused by the individual who received the prescription, or by a member of their household or a visitor. The researchers also couldn’t tell the reason for the later opioid prescription fills by those who went on to persistent use.

About the Author

Truman has been a bureau chief and correspondent in D.C., Los Angeles, Phoenix and elsewhere, reporting for radio, television, print and news services, for more than 30 years. Most recently, he has reported extensively on health and consumer issues for ConsumerAffairs.com and FairfaxNews.com.